Provider Demographics
NPI:1629480777
Name:BAGE, MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:BAGE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1539
Mailing Address - Country:US
Mailing Address - Phone:716-566-7771
Mailing Address - Fax:716-873-0564
Practice Address - Street 1:262 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14217-1539
Practice Address - Country:US
Practice Address - Phone:716-566-7771
Practice Address - Fax:716-873-0564
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27842101YA0400X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor